Provider Demographics
NPI:1184672750
Name:JONES, HARRIET (MD)
Entity Type:Individual
Prefix:
First Name:HARRIET
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23666
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39225-3666
Mailing Address - Country:US
Mailing Address - Phone:601-200-4860
Mailing Address - Fax:601-200-4887
Practice Address - Street 1:971 LAKELAND DR STE 250
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216
Practice Address - Country:US
Practice Address - Phone:601-200-4860
Practice Address - Fax:601-200-4887
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS174400000X
MS16449207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04189871Medicaid
MS440000032Medicare PIN
MS302I117073Medicare PIN
MSP01077292Medicare PIN
MS302I447679Medicare PIN